Coverage tools
Prior authorization
6,799 Medicare Part D prior-authorization rules indexed from CMS SPUF (Standard Public Use File). Step therapy, quantity limits, tier assignments — authoritative, updated quarterly.
Why only Medicare Part D?
Medicare Part D formularies are published by CMS and we can cite them. Commercial plan rules vary by plan + year + region and aren't reliably published in a machine-readable form — so we don't surface them here. For your commercial plan, check your insurer's formulary PDF directly (“drug list” on the member site) or ask your pharmacist to run a test claim.
| Drug | Payer | PA | Step therapy | Tier |
|---|---|---|---|---|
| Gazyva obinutuzumab | — Medicare Part D | — | — | — |
| ENSACOVE ensartinib | — Medicare Part D | — | — | — |
| IBANDRONATE SODIUM Ibandronate sodium | — Medicare Part D | — | — | — |
| Amlodipine besylate and Olmesartran medoxomil Amlodipine besylate and Olmesartran medoxomil | — Medicare Part D | — | — | — |
| Sodium Citrate and Citric Acid Sodium Citrate and Citric Acid | — Medicare Part D | — | — | — |
| Bupropion Hydrochloride XL Bupropion Hydrochloride | — Medicare Part D | — | — | — |
| UREA Urea | — Medicare Part D | — | — | — |
| NOXAFIL posaconazole | — Medicare Part D | — | — | — |
| TIZANIDINE HYDROCHLORIDE tizanidine hydrochloride | — Medicare Part D | — | — | — |
| Donepezil memantine hydrochloride and donepezil hydrochloride | — Medicare Part D | — | — | — |
| MARGENZA margetuximab-cmkb | — Medicare Part D | — | — | — |
| NP Thyroid 15, NP Thyroid 120, NP Thyroid 30, NP Thyroid 60, NP Thyroid 90 | — Medicare Part D | — | — | — |
| PRED FORTE prednisolone acetate | — Medicare Part D | — | — | — |
| Saxagliptin and Metformin saxagliptin and metformin | — Medicare Part D | — | — | — |
| Nexavar sorafenib | — Medicare Part D | — | — | — |
| TYKERB lapatinib | — Medicare Part D | — | — | — |
| VARENICLINE TARTRATE, VARENICLINE | — Medicare Part D | — | — | — |
| COPPER COPPER | — Medicare Part D | — | — | — |
| LOJAIMIESS levonorgestrel/ethinyl estradiol and ethinyl estradiol | — Medicare Part D | — | — | — |
| Octreotide Acetate Octreotide Acetate | — Medicare Part D | — | — | — |
| Ciprofloxacin and Dexamethasone Ciprofloxacin and Dexamethasone | — Medicare Part D | — | — | — |
| Dialyvite Supreme D Ascorbic Acid, Cholecalciferol, Alpha-Tocopherol, Thiamine, Riboflavin, Niacinamide, Pyridoxine, Folic Acid, Cobalamin, Biotin, Pantothenic Acid, Zinc, Selenium | — Medicare Part D | — | — | — |
| Mylotarg gemtuzumab ozogamicin | — Medicare Part D | — | — | — |
| Cyclophosphamide Cyclophosphamide | — Medicare Part D | — | — | — |
| SODIUM PHENYLACETATE AND SODIUM BENZOATE sodium phenylacetate and sodium benzoate | — Medicare Part D | — | — | — |
| LEVETIRACETAM solution Levetiracetam | — Medicare Part D | — | — | — |
| IMDELLTRA (AMG757) Tarlatamab-dlle | — Medicare Part D | — | — | — |
| PREVDUO neostigmine methylsulfate and glycopyrrolate | — Medicare Part D | — | — | — |
| Effexor XR VENLAFAXINE HYDROCHLORIDE | — Medicare Part D | — | — | — |
| Desmopressin Acetate Desmopressin Acetate | — Medicare Part D | — | — | — |
| Thiotepa Thiotepa | — Medicare Part D | — | — | — |
| GLYRX-PF glycopyrrolate | — Medicare Part D | — | — | — |
| Psorinum Psorinum | — Medicare Part D | — | — | — |
| Nortriptyline HCL Nortriptyline HCL | — Medicare Part D | — | — | — |
| Prenate Chewable calcium carbonate, cholecalciferol, magnesium oxide, boron, folic acid, pyridoxine hydrochloride, cyanocobalamin, biotin and bilberry | — Medicare Part D | — | — | — |
| Hydrocortisone Hydrocortisone | — Medicare Part D | — | — | — |
| Depo-Provera medroxyprogesterone acetate | — Medicare Part D | — | — | — |
| Sucralfate Sucralfate | — Medicare Part D | — | — | — |
| KOLORZ SIXTY SECOND FLUORIDE FOAM TRIPLE MINT, KOLORZ SIXTY SECOND FLUORIDE FOAM CHERRY CHEESECAKE, KOLORZ SIXTY SECOND FLUORIDE FOAM COTTON CANDY, KOLORZ SIXTY SECOND FLUORIDE FOAM BLUE RASPBERRY | — Medicare Part D | — | — | — |
| Amphetamine Sulfate DEXTROAMPHETAMINE SACCHARATE, AMPHETAMINE ASPARTATE MONOHYDRATE, DEXTROAMPHETAMINE SULFATE, AMPHETAMINE SULFATE | — Medicare Part D | — | — | — |
| Omega-3-Acid Ethyl Esters OMEGA-3-ACID ETHYL ESTERS | — Medicare Part D | — | — | — |
| THIAMINE HYDROCHLORIDE injection, solution Thiamine Hydrochloride | — Medicare Part D | — | — | — |
| Trospium Chloride Trospium Chloride | — Medicare Part D | — | — | — |
| PaxLyte leucovorin, folic acid, levomefolate magnesium, ferrous cysteine glycinate, 1,2-docosahexanoyl-sn-glycero-3-phosphoserine calcium, 1,2-icosapentoyl-sn-glycero-3-phosphoserine calcium, phosphatidyl serine, pyridoxal 5-phosphate, flavin adenine dinucleotide, nadh, cobamamide, cocarboxylase (thiamine pyrophosphate), magnesium ascorbate, zinc ascorbate, magnesium l-threonate and betaine capsule | — Medicare Part D | — | — | — |
| Adderall XR Dextroamphetamine Sulfate, Dextroamphetamine Saccharate, Amphetamine Sulfate and Amphetamine Aspartate | — Medicare Part D | — | — | — |
| Austedo, AUSTEDO, AUSTEDO XR | — Medicare Part D | Yes | — | — |
| Paroxetine Paroxetine | — Medicare Part D | — | — | — |
| Glycopyrrolate Glycopyrrolate | — Medicare Part D | — | — | — |
| CIDOFOVIR DIHYDRATE Cidofovir Dihydrate | — Medicare Part D | — | — | — |
| SUBLOCADE buprenorphine | — Medicare Part D | — | — | — |